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Skills: NCQA HEDIS, CMS Core, Performance Improvement, Data Analysis, Medicaid Managed Care
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Full-time
bachelor degree, postgraduate degree
Posted 2d ago
~40 hrs/week
Responsibilities
Oversee performance measure monitoring and improvement for the Medicaid Segment's managed care organization across behavioral and physical health. Drive quality metrics through the development of system-wide improvement projects and the supervision of monitoring functions.
Requirements
Requires a Bachelor's degree and at least 5 years of experience in the healthcare payer or provider space. Proficiency in NCQA HEDIS and CMS Core methodologies is essential, with a preference for a Master's degree and CPHQ certification.
Full job description
Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:
Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
Onsite: daily onsite requirement based on the essential functions of the job
Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building
Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.
This position is hybrid within the state of AZ only. This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.
PURPOSE OF THE JOB
The position is responsible for managing Quality Improvement activities as well as staff conducting quality improvement work as outlined in AHCCCS contract and policy for the Medicaid Segment. This position and staff reporting to this position shall reside in Arizona within the Geographical Service Area for contract compliance, have knowledge of both physical and behavioral health service delivery, monitor, review and evaluate performance measure data and technical specifications. The employee holding this position shall not hold any other position within the organization.
QUALIFICATIONS
REQUIRED QUALIFICATIONS
Required Work Experience
5 years experience in the health care payer or provider space
Required Education
Bachelor’s Degree
Required Licenses
N/A
Required Certifications
CPHQ through the National Association for Health Care Quality (NAHQ) or is a CHCQM through the American Board of Quality Assurance and Utilization Review Physicians
PREFERRED QUALIFICATIONS
Preferred Work Experience
10 years healthcare experience, within the Arizona Medicaid system preferred
Experience leading system-wide interdisciplinary improvement projects
Preferred Education
Master’s degree in business, healthcare administration or healthcare related field
Preferred Licenses
N/A
Preferred Certifications
N/A
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
Responsible for driving performance improvement for National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) and other quality metrics
Develops and implements system-wide performance improvement projects
Development and monitoring of Corrective Action Plans for effectiveness in achieving performance targets and reporting on effectiveness of recommended actions
Collaborates with internal departments including Quality Management, Performance Improvement and Quality Analytics on NCQA HEDIS performance measurement to ensure data integrity
Supervises employees performing performance improvement and monitoring functions
Reports quality improvement and performance outcomes to leadership, regulatory bodies and stakeholders
Analyzes data and communicates results and recommendations with internal and external staff and provider agencies
Monitors and tracks provider performance and data from multiple sources to identify and respond to trends and or emerging issues and to ensure compliance with minimum standards
Utilizes data to develop intervention strategies to improve outcomes and reports quality improvement and performance outcomes as requested to ensure ongoing compliance with contractual requirements
Conducts research, reviews, analyzes and compiles data, develops recommendations and reports
Some travel is required to attend meetings with AHCCCS, provider agencies and other meetings as assigned
The position has an onsite expectation of 2 days per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
Perform all other duties as assigned
COMPETENCIES
REQUIRED COMPETENCIES
Required Job Skills
Subject matter expertise with NCQA HEDIS and CMS Core performance measure calculation and data collection methodologies
Experience with Medicaid managed care organizations
Proven record of accomplishment working with executives across a multi layered organizational platform
Proficiency in developing and presenting analytic reports including written and verbal communication, data collection, sampling, analysis and presentation
Excellent analytical and problem solving skills
Ability to establish trust with all levels of stakeholder groups
Exceptional interpersonal, influence, collaboration and listening skills
Strong written communication skills including ability to use Microsoft applications such as MS Project, Word, Excel and PowerPoint
Ability to maintain confidentiality, privacy and security of protected information
Required Professional Competencies
Strategic and consultative approach to program management
Strong analytical skills with ability to quickly identify issues, root causes and solutions
Ability to make decisions confidently and work independently
Flexible and willing to adjust to changing priorities
Required Leadership Experience and Competencies
Confidence working with all levels of the organization and external partners
Collaborative and motivational leadership style across multiple teams
Ability to handle sensitive and confidential situations with professionalism and diplomacy
PREFERRED COMPETENCIES
Preferred Job Skills
Advanced PC proficiency with word processing, spreadsheets and presentation software
Experience with Daptiv preferred
Preferred Professional Competencies
N/A
Preferred Leadership Experience and Competencies
N/A
Our Commitment
AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.
Blue Cross ® Blue Shield ® of Arizona (AZ Blue) is committed to helping Arizonans get healthier faster and stay healthier longer. With a mission to inspire health and make it easy, AZ Blue offers health insurance and related services to more than 2 million customers. AZ Blue, a non-profit company, is an independent licensee of the Blue Cross Blue Shield Association. The company and its subsidiaries employ more than 3,200 people in its Phoenix, Flagstaff, and Tucson offices.
Offices: 8220 N 23rd Ave, Phoenix, Arizona 85021, US
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How many Data & Analytics jobs are open in Phoenix, AZ right now?
There are currently 674 open data & analytics positions in Phoenix, AZ listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Data & Analytics roles in Phoenix, AZ?
Companies currently hiring include American Express, Bright Vision Technologies, Arizona Department of Transportation, Republic Services, Arizona Public Service - APS, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Data & Analytics jobs in Phoenix, AZ?
Yes — 354 of the 674 open data & analytics positions offer remote or hybrid work (91 remote, 263 hybrid).
How do I apply for Data & Analytics jobs in Phoenix, AZ?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.